Competitive sdpi FY 2023 - greenville rancheria tribal health clinic (gvrthc) has been working for 25 years to treat and prevent diabetes in AI/an communities

Gvrthc serves tehama and plumas counties, where most residents live in rural areas with limited access to health services and 3% identify as AI/an. In 2021, the dixie fire burned much of plumas county, including one of our clinics, creating greater barriers to access health care services. Despite these challenges, gvrthc has continued to identify community needs and provide a multi-faceted approach to address diabetes. According to data from 2021 audit reports and community input, lack of eye exams, prevalence of obesity, and commercial tobacco use were identified as top diabetes-related health issues within the community and will be the focus area of this funding. The program will focus on implementing the best practice activity of increasing eye exams for retinopathy and outreach, perform, and track these services. Additionally, funding will be used to screen, refer, and provide prevention services for commercial tobacco cessation and obesity prevention. The target population for this program are the 100 active adult AI/an patients who are diagnosed with type 2 diabetes. This program has tremendous support from tribal and clinic leadership who participate in regular care team meetings and support the coordination of work among clinic departments. Additionally, the program will be implemented by the diabetes care team, a team of well trained medical professionals that formed in 2021 to support diabetes prevention services within the clinic. The program's impact and success will be tracked through tracking sheets and reports from electronic health records.